Zoonotic diseases are diseases that are transmitted from animals or vectors to humans and vice versa. The public together with veterinarian authorities should readily access disease information as it is vital in rapidly controlling resultant zoonotic outbreak threats through improved awareness. Currently, the reporting of disease information in South Africa is predominantly limited to traditional methods of Information Communication Technologies (ICTs) like faxes, monthly newspaper reports, radios, phones and televisions. Although these are effective ways of communication, their disadvantage is that the information that most of them offer can only be accessed at specific times during a crisis. New technologies like the internet have become the most efficient way of distributing information in near-real-time. Many developed countries have used web-based reporting platforms to deliver timely information through temporal and geographic visualisation techniques. There has been an attempt in the use of web-based reporting in South Africa but most of these sites are characterised by heavy text which makes them time consuming to use or maintain. As a result most sites have not been updated or have ceased to exist because of the work load involved. The success of web reporting mechanisms in developed countries offers evidence that web-based reporting systems when appropriately visualised can improve the easy understanding of information and efficiency in the analysis of that data. In this thesis, a web-based reporting prototype was proposed after gathering information from different sources: literature related to disease reporting and the visualisation of infectious diseases; the exploration of the currently deployed web systems; and the investigation of user requirements from relevant parties. The proposed prototype system was then developed using Adobe Flash tools, Java and MySQL languages. A focus group then reviewed the developed system to ascertain that the relevant requirements had been incorporated and to obtain additional ideas about the system. This led to the proposal of a new prototype system that can be used by the authorities concerned as a plan to develop a fully functional disease reporting system for South Africa.

The HIV and AIDS epidemic continues to affect communities worldwide particularly so in South Africa. Youth, also the so-called Coloured youth, continue to remain at risk of infection, in spite of having been exposed to information about HIV and AIDS. This study explores the views of Coloured secondary school youth in a rural town in the Eastern Cape, on HIV and AIDS. Fifteen secondary school learners, both boys and girls, from Grades 10 to 12 were purposively selected. This qualitative study, framed within an interpretivist paradigm, draws on a phenomenological methodology. The data was generated from using drawing and focus group interviews and analysed using thematic analysis. The research adhered to ethical principles and trustworthiness was ensured. Constructivism and Bronfenbrenner’s bio-ecological systems theory were used to frame the study and to make meaning of the findings. In response to the primary research question, What views do Coloured youth attending a secondary school in a rural town have of HIV and AIDS?, five themes emerged, namely: individuals spread HIV, impoverished family life increases youth vulnerability to HIV, youth under pressure from peers knowingly engage in risky behaviour, misconceptions fuel the epidemic, and HIV and AIDS “captures the community in its net”. Drawing on the findings and in response to the secondary research question, What guidelines can be developed to assist educators to facilitate learners taking action against the spread of HIV and AIDS?, several guidelines were developed. They suggest that teachers should use participatory pedagogies to engage secondary school learners when teaching HIV and AIDS, build self-esteem in their learners, assist learners in dealing with peer pressure, engage learners in erasing misconceptions, and enable learners to break free from being “caught in the net” of HIV and AIDS. Collectively these guidelines could enable learners to take action in protecting themselves and their community against the spread of the HI virus. The study concludes that the views that Coloured secondary school learners from a rural town have about HIV and AIDS show their awareness of the realities of the epidemic affecting the individual, the family, the school and their community. They have constructed their views of HIV and AIDS in a way which shows their understanding of the complexities of the epidemic.

The HIV and AIDS pandemic have become not only a health concern but educational and social concern as well. According to Beyers and Hay (2011, p. 99) many school-going children are not only affected by HIV but a large number of adolescents are also either HIV positive or have AIDS. Other researchers argue that education should act as a vaccine against new HIV infections (Kendall and O’Gara, 2007, p. 6). This argument comes with the expectation that all teachers are willing and ready to work with learners made vulnerable by HIV and AIDS; without considering the lived realities of the teachers in relation to HIV and AIDS. While many teachers make a difference in the lives of affected and infected learners through the way in which they deal with the learners concerned, some may not take up the challenge to assist the learners, while others might unknowingly and unintentionally do harm. This study, therefore, aimed at exploring high school teachers’ experiences of working with learners made vulnerable by HIV and AIDS in order to generate guidelines to assist teachers to effectively deal with vulnerable learners in their classrooms.

Epidemiologists engage in the study of the distribution and determinants of health-related states or events in human populations. Eventually, they will apply that study to prevent and control problems and contingencies associated with the health of the population. Due to the spread of new pathogens and the emergence of new bio-terrorism threats, it has become imperative to develop new and expand existing techniques to equip public health providers with robust tools to predict and control health-related crises. In this dissertation, I explore the effects caused in the disease dynamics by the differences in individuals’ physiology and social/behavioral characteristics. Multiple computational and mathematical models were developed to quantify the effect of those factors on spatial and temporal variations of the disease epidemics. I developed statistical methods to measure the effects caused in the outbreak dynamics by the incorporation of heterogeneous demographics and social interactions to the individuals of the population. Specifically, I studied the relationship between demographics and the physiological characteristics of an individual when preparing for an infectious disease epidemic.

Infectious diseases are the major cause of human death worldwide and the need for new generations of anti-infective agents to overcome the drug resistant urgently needs to be tackled. Plant natural products are potential sources of novel antimicrobial compounds. In this study, an investigation into the antimicrobial lead compounds from Michelia figo, Macleaya cordata and Ardisia gigantifolia in Lingnan region is presented. The prevention of dental diseases is targeted at the control of dental biofilm. Streptococcus mutans and S. sobrinus are the leading bacterial strains in the formation of dental biofilm. Extracts of Michellia figo and Macleaya cordata displayed antimicrobial potential in our screening assays. Bioassay-guided isolation of M. figo revealed the presence of artabotryside B and acteoside which were isolated for the first time from this plant. Moreover, chelerythrine and sanguinarine, the two alkaloids isolated from Macleaya cordata displayed the ability to prevent the formation of biofilms of S. mutans and S. sobrinus with the MIC50 values in the range of 18.5-34.0 μM. Anti-TB bioassay-guided isolation of the extract of Ardisia gigantifolia led to isolation of two 5-alkylresorcinols, 5-(8Z-heptadecenyl) resorcinol (1) and 5-(8Z-pentadecenyl) resorcinol (2). We further synthesized 15 derivatives based on these two compounds. Resorcinols 1 and 2 exhibited anti-TB activity with MIC values at 34.4 μM and 79.2 μM in MABA assay, respectively, and 91.7 μM and 168.3 μM in LORA assay, respectively. Among these derivatives, compound 8 was found to show improved anti-TB activity than its synthetic precursor (2) with MIC values at 42.0 μM in MABA assay and 100.2 μM in LORA assay. Chelerythrine and sanguinarine are the representative and the major active constituents of M. cordata. Both compounds showed significant fungicidal effects in vitro and significant therapeutic effects on guinea pigs of dermatophytosis. Mechanism study for the antifungal efficacy showed that chelerythrine and sanguinarine were potent inhibitors of ergosterol bio-synthesis by reducing the amount of ergosterol without affecting the synthesis of 1,3-β-glucan. In summary, these results highlight the promising antimicrobial activity of chelerythrine, sanguinarine and alkylresorcinols from the medicinal plants in Lingnan region. The active compounds may be regarded as new hits for further study as novel classes of antimicrobial agents for the treatment of infectious diseases.

Magister Public Health - MPH / Background: Childhood obesity is on the rise in South Africa (SA) and child-directed marketing (CDM) is one of the contributing factors to children’s unhealthy food choices and consumption. This study assessed CDM on pre-packaged breakfast cereals available in South African supermarkets and describe the nutrient composition of these pre-packaged products. Methods: A descriptive observational study of CDM on pre-packaged breakfast cereals was undertaken with quantitative analysis of the nutrient composition of these products. Secondary data from the “Researching obesogenic food environments in South Africa and Ghana” study in 2019 was examined. An independently reviewed codebook of definitions of CDM was developed and breakfast cereals were assessed to identify CDM. The CDM questionnaire was developed in REDCap, an online research database and data captured therein. Statistical Package for Social Sciences (SPSS) was used for cross tabulations and one-way ANOVAs. All analysis with p value < 0.05 was taken as significant.

Thesis (M.A. Pharm. (Pharmacy Practice) -- University of Limpopo, 2020 / Background: Non-communicable chronic disease contributes to premature mortality in SA, threatening the socio-economic development of the country. The efficient management of essential medicines supply at the clinic level is vital as stock-outs of the medicines increase morbidity and mortality. Objectives: The study aimed to identify and determine the challenges in the inventory management of medicine for the treatment of non-communicable chronic diseases at public health clinics in the Dikgale community of Limpopo province. Methods: The study used a cross-sectional quantitative research design; the purposive sampling technique was used, as it requires people with specific skills, knowledge, and expertise. A Pre-validated questionnaire was used to collect data from pharmacists, professional nurses, and transport personnel. Stock card utilization review and checklist were used to verify the answers obtained from the participants. Descriptive and inferential statistics were used to analyse the data collected. All these processes ensure that stock is always available and at optimal levels. The availability of stock at optimal levels is dependent on the personnel following SOPs. Results: In total, 40% of pharmacists indicated to have never trained nursing personnel on stock management, and 66.7% which, is the majority of nursing personnel, reported they have never been trained on stock management. Only 26.67% of medicines used for NCDs did not have stock cards. The study further found that the stock-card was not used every time a transaction was made. Thirty-nine (39%) percent of the respondents did not know how to quantify order quantities; this factor contributes to stock-outs experienced at clinics. All the clinics did not have a secure dedicated area. Deliveries are offloaded outside the medicine room. Conclusions: There is a training gap that needs to be closed to meet the minimum requirements as per GPP guidelines and also help to reduce medicine stock-outs as personnel will be well equipped to handle stock. In terms of inventory management and stock control systems, all primary healthcare sectors used a manual/paper-based inventory management system. Stock control systems are in place but were not always utilised and, processes are not consistent among staff members across clinics. With distribution, it would work better if nursing personnel dedicated a person to place and receive orders as discrepancies will be picked up sooner, and quantities will be sufficient to last until the next ordering date. None of the clinics complied with “Ideal Clinic” standards for infrastructure, storage, and inventory management. / VLIR

Bakgrund: Patienter med smittsamma sjukdomar kan ibland behövas vårdas inom isolering, detta för att bryta en smittkedja och det är sjuksköterskan som har omvårdnadsansvaret. Smittsamma sjukdomar kan spridas på olika sätt exempelvis genom kontakt-, dropp- eller luftburen smitta. Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelse av att vårda patienter med smittsamma sjukdomar inom isolering. Metod: En beskrivande litteraturstudie med 11 vetenskapliga artiklar, inhämtade från databaserna PubMed och Cinahl, varav nio kvalitativa, en kvantitativ och en mixed analys. Huvudresultat: Sjuksköterskorna var rädda för nya virusutbrott, de var rädda att bli smittade eller att bidra till smittspridning. Det fanns oro i om sjuksköterskorna gjorde rätt etiska val när det kom till patientens psykosociala behov. En oro och okunskap över hur bra skyddsutrustningen som användes egentligen var. Detta i sin tur ledde till ångest, utmattning och utbrändhet. Trots detta upplevde sjuksköterskorna sin profession som viktig och nödvändig i samhället. Slutsats: Denna studie har tydligt visat sjuksköterskans negativa upplevelser så som oro, osäkerhet, ovisshet och rädsla att vårda patienter med smittsamma sjukdomar. Sjuksköterskorna upplevde bristande information vid nya virusutbrott samt en rädsla kring skyddsutrustningen. De upplevde även en stigmatisering från samhället och familj. Samtidigt sågs det ett litet samband av positiva upplevelser vilket var att sjuksköterskorna utvecklades, stärktes och såg sitt arbete som värdefullt. Mer forskning skulle kunna ge sjuksköterskan bättre förståelse och hantering av patienter med smittsamma sjukdomar. / Background: Patients with contagious diseases sometimes need isolation care, this to break the chain of infection and it is the nurse who has the responsibility for nursing. Infectious diseases can be spread in different ways, for example through contact, drip or airborne infection. Aim: The aim of the study was to examine nurses' experiences caring for patients with infectious diseases in isolation. Method: A descriptive literature study of 11 articles, from the databases PubMed and Cinahl, 9 qualitative, 1 quantitative and 1 mixed analysis. Main results: Nurses were worried about new virus outbreaks, becoming infected and spreading the disease, as well as whether or not they were making ethical decisions regarding the patients' psychosocial needs. Furthermore, the nurses were concerned about how good the protective equipment used was. This, in turn, contributed to anxiety, fatigue, and burnout. Despite these issues, the nurses considered their profession as important and necessary in society. Conclusion: This study has clearly shown the nurse's negative experiences such as anxiety, uncertainty, mistrust and fear of caring for patients with contagious diseases. The nurses experienced a lack of information in the event of new virus outbreaks and worried about the protective equipment. They also experienced a stigma from society and their families. However, there was a small connection of positive experiences, which was that the nurses were developing, strengthening, and appreciating their work. More research could give the nurses a better understanding and could lead to better management of patients with infectious diseases.

Philosophiae Doctor - PhD / Background Overweight/obesity is a risk factor for non-communicable diseases such as cardiovascular diseases, diabetes, and some cancers. Obesity in childhood is known to predict later obesity in adolescence and adulthood. Understanding the factors associated with overweight/obesity among children may present an opportunity for timely and appropriate interventions in the African setting. Aims 1. To describe the prevalence of overweight and obesity and associated factors among school children aged 8 - 11 years in primary schools in Adentan Municipality, Ghana. 2. To review the available literature on childhood obesity in the African context to provide evidence to support the design and improvement of appropriate school-based interventions for the prevention and control of overweight/obesity among African learners. Methodology This was a cross-sectional study design which was conducted in two phases. In Phase I, the available literature on the prevalence of overweight and obesity among learners, school-based interventions to promote healthy nutrition and physical activity (PA), and weight status, and key policy interventions at the national levels to provide supportive environments in the African context was reviewed and synthesised. In Phase II, interviews were conducted to collect individual and family data from 543 learners in 14 schools to assess family socio-demographics characteristics, dietary, PA, and sedentary behaviours, and sleep duration. Body weight, height, and waist circumference were measured. Data on perceived school neighbourhood/ community, school food, and PA environments were collected from school heads/administrators. A sub-sample of 183 children participated in the assessment of body fat using the deuterium dilution method. Multivariable and logistic regressions, multilevel logistic regressions, and multilevel linear regression models were used to examine the associations among child, family, and school level explanatory variables, and overweight/obesity, abdominal obesity and body mass index (BMI). Results The reviews revealed the following: (i) The pooled overweight and obesity estimates across Africa were: (10.5% 95% CI: 7.1-14.3) and 6.1% (3.4-9.7) by World Health Organization; 9.5% (6.5-13.0) and 4.0% (2.5-5.9) by International Obesity Task Force; and 11.5% (9.6-13.4) and 6.9% (5.0-9.0) by Centers for Disease Control and Prevention, respectively and differed for overweight (p=0.0027) and obesity (p<0.0001) by the criteria. The estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year, and sample size; (ii) Although inconsistent, school-based interventions broadly improved weight status and some energy-balance related health behaviours of African learners; (iii) On applying the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, key interventions on unhealthy diets and physical inactivity targeted the school, family and community settings, and macro environments, and broadly aligned with global recommendations. In the school-based study, 16.4% of Ghanaian learners were overweight (9.2%) or obese (7.2%), with the prevalence being significantly higher in children from middle- to high socio-economic status (SES) households, and private schools. In multivariable regression models, attending private school (AOR = 2.44, 1.39–4.29) and excessive television viewing (AOR = 1.72, 1.05–2.82) significantly increased the likelihood of overweight/obesity, whereas adequate sleep (AOR = 0.53, 0.31–0.88), and active transport to and from school (AOR = 0.51, 0.31 – 0.82) decreased the odds. Using deuterium-derived percent body fat as criterion method, the published BMI criteria was found to be highly specific but with moderate sensitivity for diagnosing obesity among Ghanaian children. Moreover, the BMI-for-age z-scores that optimise sensitivity, specificity, and predictive values for obesity were lower than the published cut-off points. Multilevel logistic and linear regression analyses revealed that the school contextual level contributed 30.0%, 20.6% and 19.7% of the total variance observed in overweight (including obesity), abdominal obesity, and BMI respectively. Availability of school cafeteria (β = 1.83, p = 0.017) and shops (β = 2.34, p = 0.001), healthy foods (β = 0.77, p = 0.046), less healthy foods (β = 0.38, p = 0.048), child age (β = 0.40, p = 0.008), school-level SES (β = 1.02, p < 0.0001), private school attendance (β = -1.80, p = 0.006), and after-school recreational facilities (β = 0.89, p < 0.0001) were all associated with BMI. In the mutually adjusted models for all significant predictors, school-level SES, healthy foods, after-school recreational facilities, and PA facility index remained significant predictors of overweight and or abdominal obesity. Conclusions The prevalence of overweight/obesity is significantly higher in urban children attending private or high SES schools, regardless of criteria used to define obesity. A number of individual, family, and school-level factors significantly predicted weight status of school children in Ghana. Given that many African governments have initiated policy interventions aiming to provide supportive environments for healthy choices, it is recommended that resources are made readily available for the implementation of these interventions across the home, school and community.

Master of Public Health - MPH / Non-communicable diseases (NCDs) are the leading cause of death globally, affecting a significant proportion of the economically active population, the majority of these occurring in low- and middle-income countries (LMICs). In South Africa, over 40% of deaths are attributable to NCDs. The use of healthcare services by individuals who have NCDs is putatively high but has yet, not been adequately quantified. Furthermore, there is a paucity of research data on factors that influence healthcare services use among those experiencing NCDs in South Africa.